Healthcare Provider Details

I. General information

NPI: 1750640991
Provider Name (Legal Business Name): ALEXANDER T CAUGHRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 12/01/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR STE G500
HUNTINGTON WV
25701
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR STE G500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1262
  • Fax: 304-691-1666
Mailing address:
  • Phone: 304-691-1262
  • Fax: 304-691-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25868
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: